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What is Comprehensive Cancer Control?
According to the Centers for Disease Control and Prevention (CDC), viewed at the following link: http://www.cdc.gov/cancer/ncccp/index.htm, Comprehensive Cancer Control (CCC) is “a collaborative process through which a community and its partners pool resources to promote cancer prevention, improve cancer detection, increase access to health and social services, and reduce the burden of cancer.”
Why is Comprehensive Cancer Control Important to Cherokee Nation?
National statistics show that mortality rates for cancer are higher in American Indians than those of other races in the United States. Current statistics indicate an increasing incidence in the American Indian population. With this new emerging pattern, mortality rates are also increasing. A comprehensive examination of cancer in the Cherokee Nation Tribal Jurisdictional Service Area (CNTJSA) will guide our understanding of what patterns are developing, why the patterns are developing, and what we can do to address the cancer needs in Cherokee Nation.
The Cherokee Nation Comprehensive Cancer Control (CNCCC) project will seek to:
- Research and implement evidence based strategies and best practices that will reduce the cancer mortality rate of the American Indians who reside in the Cherokee Nation,
- Develop, maintain, evaluate and renew programs, resources, and interventions that will assure the Nation's capacity to diminish the cancer burden,
- Expand the knowledge base in medical, clinical, hospital and community settings regarding cancer issues among Cherokee Nation citizens in order to promote prevention, decrease mortality, and increase quality of life for Cherokee people.
Our Comprehensive Cancer Control Goals
To assist in addressing the cancer needs in Cherokee Nation through prevention and early detection, and to insure cancer patients receive:
- Quality care when accessing treatment,
- Improved access to clinical trials,
- Patient advocates and navigators,
- Palliation assistance through hospice and other community health care programs.
How We Got Started
The Cherokee Nation Cancer Programs (CNCP) was awarded a Comprehensive Cancer Control (CCC) project grant from CDC in July 2003. The purpose of the project is to assess, identify and address the gaps and barriers involving cancer disparities in the CNTJSA for the American Indian population.
The comprehensive approach is to evaluate all programs that address prevention, early detection, treatment, quality care, palliation and end of life issues for the cancer patient and his/her family.
According to the Centers for Disease Control and Prevention (CDC), an emphasis is placed on administration, basic and applied research, evaluation, health education, program development, public policy, surveillance, clinical services and health communications.
Who are Our Partners?
Collaborative partners and committee members in the planning project include clinical and program directors, physicians, state health department personnel, nutrition specialists, community leaders, oncologists, epidemiologists, educators, tumor registrars, GIS data specialists, coordinators, survivors, and radiologists.
The CCC committee members have assessed the cancer burden in the CNTJSA by reviewing epidemiological data, Oklahoma Central Cancer Registry (OCCR) data, Indian Health Services (IHS) data, American Cancer Society (ACS) data, and the Cherokee Nation Cancer Registry (CNCR) data. Initial evaluation of services that are currently in place, patterns of care, achievements that have been made, and identified gaps that need to be filled have been completed. Once all materials were reviewed, the stakeholders jointly set priorities for action in a systematic way. The partnership worked together to mobilize support that would implement joint priorities identified. Lastly, the partnership put in place an evaluation system to monitor progress of the implementation process and to reassess priorities periodically. This will be an on-going process that will become institutionalized within the CNTJSA.
To begin the process a committee was formed which included parties employed within the Cherokee Nation and those in other organizations outside of Cherokee Nation. The purpose of the committee was to develop a working plan that would address the cancer burden within the Cherokee Nation, without duplicating efforts.
The committee chose to have monthly meetings, and workgroups presented data around their specific assignments. The following workgroups were identified and assigned the following tasks:
1. Data group – to collect cancer cases, map registry data, and design a website for CCC and Cancer Registry.
2. Resource group – to research questions by cancer site, develop material on these sites, and identify available programs.
3. Needs assessment group (whole committee) – to identify gaps in prevention, early detection, treatment, and quality of care, palliation and end of life issues pertaining to each cancer site presented.
4. Evaluation group – to evaluate workgroup performance, identify measures of effectiveness, and keep members on track.
5. Outreach group – to identify ways of providing services beyond the current services available, develop a resource manual, and identify partnerships that will be reciprocally beneficial.
6. Survivorship group – to identify survivorship issues, identify survivor groups in CNTJSA, and attend survivor meetings to gain input and insight on evolving issues.
The primary cancer sites for the CNTJSA were identified from registry data and presentations were given on the sites, which highlighted the burden of cancer in Cherokee Nation. Physicians who care for these patients also gave presentations on the standard of care at the clinics and IHS facilities.
Current programs were identified, processes and procedures were outlined, and gaps were assessed in the current programs. Standards of care, best practices, clinical trials and evidence-based strategies in the US were reviewed and discussed.
Once all information was gathered in each specific area, objectives were outlined, gaps were noted, and barriers were discussed. Strategies were then identified and prioritized in a systematic way to address all the gaps and/or barriers where feasible. This entailed developing specific, measurable, attainable, relative and time-phased (SMART) objectives where appropriate. Baseline measures for each objective and/or strategy were identified, time intervals for measurement were set, and feasible dates for completion were decided upon. Where appropriate, identification of responsibility for implementation was made and ongoing partnership recruitment will continue in order to obtain needed resources